Choledocholithiasis

Case contributed by Dr Mostafa El-Feky

Presentation

Cholecystectomy 20 years ago. Now jaundiced.

Patient Data

Age: 55 years
Gender: Female

Mild dilatation of the intrahepatic ducts with evidently dilated CBD, measuring 15 mm in caliber. The CBD and cystic stump harbor multiple stones, the largest measures 7 mm. Clear cholecystectomy bed. The pancreatic duct is not dilated.

Case Discussion

MRCP shows evidence of common bile duct and cystic stump stones with dilatation of the intra-hepatic biliary radicles. Biliary stones in a postcholecystectomy patient can be residual stones or de novo formed. The remote history of cholecystectomy (20 years), in this case, suggests de novo formation of biliary stones in both the common bile and cystic ducts. Cystic duct stump can harbor stones causing symptoms in post cholecystectomy patients. 

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